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Clinical Neuropsychologist

Leesburg, Florida

Provider NPI: 1750383006

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
26540 ACE AVE STE E-106  LEESBURG, FL 34748 US
Tel: 352-530-2317  Fax: 352-530-2180

Business Mailing Address:
26540 ACE AVE STE E-106  LEESBURG, FL 34748 US
Tel: 352-530-2170  Fax: 352-530-2180

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
N103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
N103T00000XBehavioral Health & Social Service Providers
N104100000XBehavioral Health & Social Service Providers
Social Worker

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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